Recovery Audit Contractors

Third-party firms that audit Medicare bills for payment issues are pushing back hard against a hospital association plea for more favorable short-stay reimbursements, adding to the ongoing unwelcome specter of audits among all providers, including those in long-term care.

The federal government is asking the public to suggest ways of reducing Medicare appeals and cutting down on a backlog at the administrative law judge level. The request for information was filed by the Office of Medicare Hearings and Appeals and published in today's Federal Register.

Medicare auditors would boost outreach and education efforts to long-term care and other providers under the provisions of a draft bill introduced Thursday by Rep. Kevin Brady (R-TX), chairman of the Ways and Means health subcommittee.

Medicare Recovery Audit Contractors returned $100.4 million in underpayments to healthcare providers in the third quarter of fiscal year 2014, the Centers for Medicare & Medicaid Services has announced.

The Medicare claims review process is unfairly burdening healthcare providers and failing to improve program integrity, due in part to the payment system for certain auditors, Senate leaders said during a roundtable hearing Wednesday.

One of nursing homes' most vigilant government watchdogs plans to dramatically curb its activities this year, a federal official has told the House Ways & Means Subcommittee on Health. The Department of Health and Human Services Office of the Inspector General anticipates reducing Medicare and Medicaid oversight activities overall by 20% in fiscal year 2014.

Medicare Recovery Audit Contractors dramatically stepped up their overpayment recoveries last year, returning nearly $487 million more to the government than they did in 2012, according to a new report from a federal watchdog agency.

Long-term care providers filing to have a Medicare claims appeal heard by an administrative law judge will not have the case assigned to a judge for at least two years, according to the Office of Medicare Hearings and Appeals.

Recovery audit contractors might be better at reviewing Medicare claims than critics allege, but the Centers for Medicare & Medicaid Services could improve RAC performance evaluations, according to a new government report.

The Centers for Medicare & Medicaid Services should move faster to make changes based on Medicare audits and should have more direct oversight over Medicaid, according to bipartisan legislation introduced Tuesday. "The Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2013" proposes a variety of reforms to cut down on waste, fraud and abuse. The PRIME Act was introduced by Sens. Tom Carper (D-DE) and Tom Coburn (R-OK), and Reps. John Carney (D-DE) and Peter Roskam (R-IL).

An advocacy group for independent Medicare auditors has sharply criticized two bills that would put new controls on Recovery Audit Contractors. The Medicare Audit Improvement Act of 2013 was introduced in the House of Representatives in March. A Senate version of the bill was introduced last month. The bill would rein in auditors and improve transparency, which have been provider concerns.

Providers will see fewer Additional Document Requests starting in June, as the Centers for Medicare & Medicaid Services transitions to new Recovery Audit Program contracts. CMS has started the contract procurement process by issuing a request for quotes through the General Services Administration, according to a Medicare newsletter released Thursday.

A recent Centers for Medicare & Medicaid memorandum provides some clarity regarding new therapy cap notification rules, but providers still need guidance on other aspects of therapy reimbursement, according to Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care.

Medicare recovery audit contractors (RACs) can request as few as 20 records in a 45-day period from skilled nursing facilities and other providers as of April 15, according to the Centers for Medicare & Medicaid Services. This is a reduction from the current 35-record minimum request.

As part of its pushback against the manual review process for therapy claims, the American Health Care Association has launched a clearinghouse to gather provider feedback. AHCA President Mark Parkinson described the RAC-led review process as "bifurcated, confusing and wholly inappropriate" in a four-page letter sent to Acting CMS Administrator Marilyn Tavenner last week.

A keynote address by Farzad Mostashari, MD, ScM, the National Coordinator for Health Information Technology, will highlight opening day of the annual winter Legislative and Regulatory Conference of the National Association for the Support of Long-Term Care.

Lawmakers again hammered the Centers for Medicare & Medicaid Services' Medicare program integrity contractors Friday. The latest salvos were fueled by an agency admission that additional mistakes had been made.